Assessment-of- Quality-of- Life-of- People- Living- With- HIVAIDS- In- Karnataka- State

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					INTERNATIONAL JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH VOLUME 1, ISSUE 10, NOVEMBER 2012                                           ISSN 2277-8616

       Assessment of Quality of Life of People Living
            With HIV/AIDS In Karnataka State
                               Basavarajaiah. D. M., B. Narasimha murthy, B. Leelavathy, Maheshappa K.

Abstract:- HIV not only affects the physical well being of an individual but also the overall Quality of life (QOL) . The assessment of QOL is more
important to understanding how the people’s lives are affected by HIV infection. It helps to evaluate the financial costs, benefits of new programmes to
health care providers and policymakers. The objective of present study is to determine the impact of human Immunodeficiency Virus (HIV) and HAART
treatment on PLHIV. A total of 800 HIV positive patients above 18 years of age adults, who are on HA ART and newly enrolled for HIV care in different
ART centers of Bangalore city were recruited after obtaining informed consent .ART and pre ART eligible patients were interviewed at different intervals
by using WHO-brief scale. Each client participated in three in-depth interviews (IID’s). QOL-assessment was done across a range of different
socioeconomic, physical, psychological and clinical parameters. Factorial and principle component methods were employed to find out the significant
difference between the various QOL domains. The mean age of the male and female patients was 32.14±6.30 and 32.50±6.23 years respectively. The
overall mean score on a scale of 0-100 was found to be 19.50 in pre ART, and one year after completion of HAART, the mean score was119.20.A
statistically significant QOL scores between psychological, physical and social relation domain is compared with educational status (P≤0.05).The present
study is to quantify QOL –with regard to educational status, family income, occupation, family support, immunological and clinical factors. HAART
treatment, educational status, and also good social relationships can improve the QOL.The living environment of PLHIVS is one of the most important
determinants of overall QOL, it has been suggested that QOL may be uniquely affected by specific disease process such as AIDS. Factorial analysis
and principle component- user friendly model is helpful for physicians, researchers and policymakers for taking clinical decisions and for implementation
of new programmes.



INTRODUCTION                                                                     EQUATION:
Quality of life (QOL) is a term that is popularly used to                        The patients were recruited for the QOL study with written
convey an overall sense of well-being and includes aspects                       consent; WHO QOL-BREF instrument has 26 items
such as happiness and satisfaction with life as a whole.                         grouped under four domains. The items under the domains
World Health Organization has defined QOL as "individuals'                       are: Physical health - dependence of treatment, energy and
perceptions of their position in life in the context of the                      fatigue, mobility, presence of pain and discomfort, sleep
culture and value systems in which they live and in relation                     and rest, activities of daily living, and perceived working
to their goals, standards, expectations and concerns." [1]                       capacity.
With the recent advances in clinical tests and treatments for                         1 Psychological well-being: Positive self-concept,
those suffering from human immunodeficiency virus (HIV)                                   negative feelings, higher cognitive functions, body
/acquired immunodeficiency syndrome (AIDS), the survival                                  image, and spirituality Social relations - social
of these patients has been increased and their QOL has                                    contacts, family support, sexual activity.
become an important focus for researchers and healthcare                              2 Environment:        freedom,     quality     of home
providers. [2] Since the discovery of HIV at in beginning of                              environment, physical safety and security,
the 1980s, HIV/AIDS has been one of the greatest health                                   involvement in recreational activity, quality of
problems in the world. [3] HIV/AIDS places an increasing                                  health and social care, and accessibility to
burden on the health of the population, and causes further                                services.
socioeconomic        problems for individuals, families,                              3 Physical:
communities, NGO’s and governments in many                                            4 Social relationship:
countries.[4],[5] HIV is increasingly considered a chronic
disease. For a person living with HIV, this means having to                      There are also two items examined separately. One about
cope up with a range of HIV-related symptoms for entire life                     the individual’s overall perception of QOL and the other
. Symptoms may be related to the infection itself, co morbid                     about the individual’s overall perception of his or her health.
illnesses or iatrogenic effects from HIV-related medications.                    Each item uses a five –point Likert –type scale. All 26 items
        Many of the HIV patients struggle with numerous social                   were checked and scores ranging from 1-5 were assigned.
problems such as stigma, discrimination, poverty,                                Scores of three negatively phrased items were reversed.
depression, substance abuse, and cultural beliefs which                          Scores were transformed to 0-100 scale using of WHO
can affect their QOL not only from the physical health                           QOL-BREF instrument. Cases with greater than 15 % of
aspect, but also from the mental and social health point of                      missing data were deleted and the data set were saved.
view and causes numerous problems. [8] Assessing health-                         Collected data were analyzed by using SPSS-16.50
related quality of life (HRQOL) is useful for documenting the                    version; Factorial and Univariate analysis were employed to
patients' perceived burden of chronic disease, tracking                          find out the correlation between different HRQOL domains,
changes in health over time, assessing the effects of                            Chrobanch “α” value was used for testing the hypothesis.
treatment and quantifying the return on health care                              The following factors were pooled and calculated on
investment. In the context of present study, the aim is to                       transformed scale
find out the association between different aspects of QOL in
PLHIV.                                                                           Transformed scale = (Actual score - Lowest possible raw
                                                                                 score/Possible score) * 100
INTERNATIONAL JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH VOLUME 1, ISSUE 10, NOVEMBER 2012                                         ISSN 2277-8616

F 1 (Domain 1) =Physical health.                                                        which can be grouped in to certain factors that may explain
F 2 (Domain 2) =Psychological.                                                          the interrelation ship amongst a large number of variables
F 3 (Domain 3) =Social relationship/level of independence.                              of PLHIV.”Communalities” is a measure of the amount of
F 4 (Domain 4) = Environment.                                                           variables- variance that is explained by the extracted
                                                                                        factors and is obtained by adding the square of factor
MODEL FORMULATION:                                                                      loading of the ten factors. The higher the variable
x1 = λ 1 F 1 +e 1   x 1 = λ 1 F 2 +e 1 x1 = λ 1 F 3 +e 1 x1 = λ 1 F 4 +e 1              Communalities, the more are the comman factors explained
                                                                                        by single factors. As all the variables have higher factor
x2 = λ 2 F 1 +e 2 x 2 = λ 2 F 2 +e 2 x2 = λ 2 F 3 +e 2 x2 = λ 2 F 4 +e 2                loading in case of factor F1, it means that all variables are
                                                                                        grouped together into single factor.
x3 = λ 3 F 1 +e 3 x 3 = λ 3 F 2 +e 3 x3 = λ 3 F 3 +e 3 x3 = λ 3 F 4 +e 3
                                                                                        Principle component analysis:
x4 = λ 4 F 1 +e 4   x 4 = λ 4 F 2 +e 4 x4 = λ 4 F 3 +e 4 x4 = λ 4 F 4 +e 4              ARV treatment information, details of age sex, education,
                                                                                        occupation ,cd4 count and risk bearing set of data, with
x5 = λ 5 F 1 +e 5 x 5 = λ 5 F 2 +e 5 x5 = λ 5 F 3 +e 5 x5 = λ 5 F 4 +e 5                measurement of ten variables X 1 , X 2 …….X K for each set of
                                                                                        new variables (Pi) called principle components, which are
x6 = λ6F 1 +e 6 x6 = λ 6 F 2 +e 6 x6 = λ 6 F 3 +e 6 x6 = λ 6 F 4 +e 6                   linear combination of the X’s was obtained for analysis.

x7 = λ 7 F 1 +e 7 x 7 = λ 7 F 2 +e 7   x7 = λ 7 F 3 +e 7 x7 = λ 7 F 4 +e 7

x8 = λ 8 F 1 +e 8   x 8 = λ 8 F 2 +e 8 x8 = λ 8 F 3 +e 8 x8 = λ 8 F 4 +e 8

x9 = λ 9 F 1 +e 9   x 9 = λ 9 F 2 +e 9 x9 = λ 9 F 3 +e 9 x9 = λ 9 F 4 +e 9

x10 = λ 10 F 1 +e 10 x10 = λ 10 F 2 +e 10 x10 = λ 10 F 3 +e 10 x10 =
λ 10 F 4 +e 10

X1: Age
X2: How would you rate your quality of life?
X3: How satisfied are you with your health?
X4: How satisfied are you with your capacity for work?
X5: How often do you have negative feelings such as
blue mood?
Despair, anxiety, depression?
X6: How satisfied are with the support you get from
your friends?
X7: How satisfied are you with your sex life?
X8: How satisfied are you with your personal
X9::How much do you enjoy life?

r(e i ,e j )=0 for i≠j for all pairs of I and j . The coefficient λ i
which is regression coefficient, and termed as factor
loadings. A unique factor F 1 , F 2 , F 3 , F 4 is called comman
factors. The residuals e i ‘s are called unique factors .
Unique factors regarded as a sum of an error of
measurement. From the matrix factor loading s, if λ i =0 then
the ith factor does not enter in to the account of ith variable.
In order to reduce the number of factors and hence to
enhance the interpretability, factors are rotated by
techniques like varimax rotation. Geometrically, rotation
means the tilting of factors on their axis in one direction or
another until certain variables appear to their effect. This
increases the quality of interpretation of the factors. The
varimax rotation procedure attempts to maximize the sum
of the variance of squared factor loadings in the columns of
the loading matrix and, in the process it tends to produce
some high loadings and non zero loadings on each factors.
In these techniques, the sum of squared loading of each
row of the factor loading matrix remains intact, while the
newest of orthogonal factor is obtained. In view of the
strong correlation among certain factors of variables,
factors analysis was carried out to see these variables

                                                  TABLE AND FIGURES
             Tab (1): Distribution of HIV patients according to their socioeconomic andpsychologicalcharacteristics.


    Characteristics                No. of HIV clients Percentage (%) Odd ratio 95% Confidence interval(CI) P-Value

    Male                                   465              58.12         1.04              0.59-0.89                  0.88
    Female                                 330              41.25         0.98              0.35-0.62                  0.75
    Trans gender(TS/TG)                     05              0.625         0.021            0.03-0.011                  0.21

    <20                                     72                9           3.56             0.321-0.856                 0.21
    21-30                                  418             52.25          21.23             0.66-0.963                 0.63
    31-40                                  225             28.125         10.50            0.423-0.658                 0.42
    41 &Above                               85             10.625         8.65             0.302-0.756                 0.63
    Pool                                   800              100           10.99                                        0.47
    Illiterate                             425             53.125          38.25           0.248-0.583              0.213
    Literate                               375             46.875          23.62           0.413-0.261               0.33
                                           800               50           30.935                                   0.2715
    Agriculture                            102             12.75          21.32             0.45-0.698             0.421
    Agriculture and allied                  40                5           10.26            0.789-0.211             0.365
    House wife                              45             5.625          5.12             0.563-0.745             0.111
    Commercial sex workers                  50              6.25          2.35             0.321-0.874             0.241
    Vendor                                  55             6.875          4.52              0.444-0.99              0.32
    Skilled worker                          30              3.75          3.65             0.211-0.365             0.412
    Asst worker                             45             5.625          4.21             0.453-0.869             0.605
    Salaried class                          42              5.25          3.89             0.486-0.756             0.452
    Business man                            76               9.5          4.01              0.11-0.201             0.324
    Drivers                                315             39.375         10.24            0.453-0.698             0.485
                                           800              100           6.957                                    0.376
    High income                             89             11.125          2.36             2.48-6.56               0.89
    Medium income                          148              18.5           5.48             5.36-6.23              0.145
    Low income                             563             70.375          2.96             1.24-2.48              0.231
                                           800              100             3.6                                    0.422
    Hindu                                  655             81.875         4.21             0.112-0.856              0.458
    Muslims                                102             12.75          10.56             0.236-0.78              0.023
    Christians                              43             5.375          0.65               0.24-0.63             0.0112
                                           800              100           5.14                                      0.164
    Type of family
     Nuclear                               440               55           6.52              2.36-4.56              0.523
    Joint                                  231             28.875         10.45             1.28-6.30              0.889
    Staying alone                          129             16.125         3.98              1.41-2.45              0.365
                                           800              100           6.98                                     0.632
    Marital status
    Married                                401             50.125         3.88              1.23-3.56               0.54
    Divorce                                274             34.25          15.23             4.58-8.96              0.113

    Separated                             125             15.625            2.89              3.86-7.85              0.53
                                          800              100              7.33                                     0.39
    Age at first sex and inter
    >18 Years                             563             70.375            5.36          0.398-0.635                2.36
    <18 Years                             237             29.625            8.59          0.745-0.522                5.89
                                          800              100              6.975                                   4.125
    Life time sex partners
    One partner                           158             19.75             3.78          0.231-0.765                0.36
    Two partners                          475             59.375            8.59          0.234-0.635               0.012
    Three partners                        102             12.75             6.39          0.211-0.386               0.242
    >three partners                        44               5.5             3.22          0.369-0.521               0.069
    Non responders                         21             2.625             4.52           0.112-0.23               0.542
                                          800              100               5.3                                    0.245
    Type of sex
    Anal sex
    Yes                                    35             4.375             10.25         0.638-0.987               0.234
    No                                     87             10.875            8.96          0.124-0.635               0.458
    Non responders                        678             84.75             5.47          0.489-0.963               0.635
                                          800              100              8.22                                     0.44
    Oral sex
    Yes                                    82             10.25             6.58          0.218-0.659               0.478
    No                                     45             5.625             2.49          0.487-0.635               0.698
    Non responders                        673             84.125            2.31           0.89-0.214               0.478
                                          800              100              3.79                                     0.55
    Vaginal sex
    Yes                                   735             91.875            1.26                2.31               0.0236
    No                                     28               3.5             2.36                8.56                0.123
    Non responders                         25             3.125             0.48                4.12                0.235
    Homosexual                             12               1.5             0.24                2.36                0.412
                                          800              100              1.08                                     0.19
    Seropositive Status
    One family member                     498             62.25             2.36              2.36-5.23             0.214
    Two family members                    269             33.625            4.89              1.48-6.98             0.458
    Three family members                   23             2.875             6.58              2.89-3.98             0.748
    >three family members                  10              1.25             1.48              3.28-6.89             0.352
                                          800              100              3.82                                    0.443

                             Tab (2): Total scores of different domains Of QOL (Transformed scale)

                                                                                           QOL –after one year ART
                                                   QOL-Before ART treatment
     SL.            Domains                N      Min     Max       Mean       SD      Min    Max      Mean      SD
     01.    Domain1=Physical health       800     19.5   65.10      58.10     102.1   42.16 146.23 119.20       30.20
     02.    Domain2 =Psychological        800     21.5   44.28      32.08     66.03   52.08 108.92 83.16        17.62
     03.      relationship/level of       800     14.6   40.01      18.15     59.32   36.00     96.22     65.10     38.16
     04.    Domain4 = Environment         800    10.38   32.04      13.11     98.16   21.56     85.63     50.02     40.65


                                               Fig (1): Mean scores of QOL

                              Tab (2): correlation matrix of categorical variables of PLHIV
    Categorical     Age     (X2)        (X3)         (X4)      (X5)     (X6)        (X7)      (X8)      (X9)
    variables       (X1)
    Age(X1)         1.00    0.760**     0.630*      0.252      0.321    0.124      0.859**    0.902**   0.316
    (X2)                    1.00        0.465       0.118      0.289    0.435*     0.769**    0.834**   0.341
    (X3)                                1.00        0.218      0.411    0.632*     0.698**    0.635*    0.540*
    (X4)                                            1.00       0.136    0.369      0.782*     0.617*    0.428
    (X5)                                                       1.00     0.248      0.399      0.872*    0.501*
    (X6)                                                                1.00       0.589*     0.487     0.214
    (X7)                                                                           1.00       0.888*    0.324
    (X8)                                                                                      1.00      0.142

    (X9)                                                                                                1.00


*, ** Significant at 0.05&0.01 level
X1: Age
X2: How would you rate your quality of life?
X3: How satisfied are you with your health?
X4: How satisfied are you with your capacity for work?
X5: How often do you have negative feelings such as blue mood,
Despair, anxiety, depression?
X6: How satisfied are with the support you get from your friends?
X7: How satisfied are you with your sex life?
X8: How satisfied are you with your personal relationships?
X9::How much do you enjoy life?

                              Tab (3): Strong correlation of categorical variables of HIV patients.

      Categorical variables                                                        Strong correlation
      Age(X1)                                                                      X2,X3,X7,X8,X9
      How would you rate your quality of life? (X2)                                X6,X7,X8,
      How satisfied are you with your health? (X3)                                 X6,X7X8,X9
      How satisfied are you with your capacity for work (X4)                       X7,X8
      How often do you have negative feelings such as blue mood, Despair,          X8,X9
      anxiety, depression? (X5)
      How satisfied are with the support you get from your friends? (X6)           X1,X2,X3,X4 &X7
      How satisfied are you with your sex life? (X7)                               X1,X2,X3,X4 &X8
      How satisfied are you with your personal relationships (X7)                  (X2) (X3) (X7) (X8) (X9)
      How much do you enjoy life? (X8)                                             X1,X3,X5

                                          Tab (4): Associated parameters in PLHIV.
      Categorical variables                                                                                  Communalities
                                                                          F1    F2    F3               F4
      X1: Age                                                            0.64 -0.44 0.36              0.03       0.858
      X2: How would you rate your quality of life?                       0.75 -0.12 0.14              0.07       0.732
      X3: How satisfied are you with your health?                        0.72 0.27 0.15               0.40       0.697
      X4: How satisfied are you with your capacity for work?             0.67 0.43 0.28               0.27       0.524
      X5: How often do you have negative feelings such as blue mood, 0.68 0.58 0.02                   0.17       0.602
      X6: How satisfied are with the support you get from your friends?  0.82 0.41 0.18               0.12       0.681
      X7: How satisfied are you with your sex life?                         0.83    0.08    0.25      0.34       0.923
      X8: How satisfied are you with your personal relationships?           0.75 0.15 0.30           0.24        0.964
      X9::How much do you enjoy life?                                       0.88 0.023 -0.211       -0.45        0.632
      Eigen values                                                          5.46 5.20 3.98           4.32
      Explained variation (%)                                              54.60 52.0 39.80         43.20

                          Tab (6): principle component analysis of associated parameters in PLHIV.

      Categorical variables
                                                                                     P1               P2           P3
      X1: Age                                                                       0.600          0.192          -0.169
      X2: How would you rate your quality of life?                                 -0.361          0.475          0.036
      X3: How satisfied are you with your health?                                   0.221          0.182          0.219
      X4: How satisfied are you with your capacity for work?                        0.486          -0.287         0.261
      X5: How often do you have negative feelings such as blue mood,                0.304          0.703          -0.268
      X6: How satisfied are with the support you get from your friends?             0.229          0.504          0.548


       X7: How satisfied are you with your sex life?                                 0.559         -0.335          0.148
       X8: How satisfied are you with your personal relationships?                   0.221         -0.011          0.763
       X9::How much do you enjoy life?                                              -0.401         0.412           0.364

                         Tab (7): Component transformation matrix of associated parameters in PLHIV.

            Components               P1                P2                       P3
            P1                       0.748             0.660                    0.058
            P2                       -0.642            0.681                    0.333
            P3                       0.205             -0.305                   0.922
            P4                       0.149             0.086                    -0.191
            (%) Total variance       78.15             54.21                    65.89

Proof:                                                                 401(50.12%) CI 95% 1.23-3.56 were married, Divorced-
In our study, 800 PLHIV were considered .The results                   274(34.25%) CI 95% 4.58-8.96 and Separated-
showed that males and females were 58.12% & 41.28%                     125(15.62%) CI 95% 3.86-7.85.
respectively (ODD ratio -0.98), Younger age group
predominated over older age group, IQR (21-30 years). The              563(70.73%) CI 95% 0.398-0.635 had first sexual exposure
lower the income, higher the risk of acquisition of infection.         at more than 18 years of age, 237(29.62%) CI 95% 0.745-
(Occupation and economic status of PLHIV is statistically              0.525, had at <18 years of age. Life time sex partners in
significant -P<0.05).Present study has higher prevalence in            these patients (obtained from the patients thorough, in-
drivers (39.75%) and least in Agriculturists (12.75%).                 depth interview (IID’s) and focus group interview -FGI) was
Single member infected in the family was (62.25%) with                 one partner in 158(19.75%) CI 95% 0.231-0.765, two life
ODD ratio (2.36), two family members being infected                    time partners in 475(59.37%) CI-95% 0.234-0.635, three
(33.62%) with add ratio (4.89). The factor analysis of the             partners in 102(12.75%) CI 95% 0.211-0.386 and >three
ten items of categorical variables on ranking scale was                partner 44(5.50%) CI 95% 0.369-0.421.
taken into consideration; table (3) indicated that the most
appropriate solution involved was F1, F2, F3 &F4.                      Type of sex practiced -Anal sex accounted for 35(2.61) CI
Demographic profile of the patients presented in Tab (1) –             95% 0.486- 0.963, Oral sex 82 (7.25%) CI 95% 0.218-0.654
Age, were classified and accounted for72 (9.00%) CI 95%                and vaginal sex 735(91.87%) CI 95% 2.31-3.33.
0.321-0856 ie., <20 years. 21-30 years- 418(52.25%) CI
95% 0.66-0963; 31-40years- 225(28.15%) CI 95%0; 423-                   Seropositive status in family- one infected member-
0.658 and above 41years- 85(10.62%) CI 95% 0.302-0.756;                498(62.25%) CI 95% 2.36-5.23, two infected- 269(33.62%)
425(53.12%) CI95% 0.248-0.583 patients were illiterate.                CI 95% 1.48-6.98, three infected-23(2.875) CI 95% 2.89-
                                                                       3.98 and More than three members infected was 10
The occupation of the patients were Agriculture -                      (1.25%) CI 95% 3.28-6.89. Using WHO brief
102(12.75%) CI 95% 0.45-0.698, Agriculture and allied-                 questionnaires, HRQOL, data obtained before initiation of
40(5.00%) CI 95% 0.789-0.211, House wives -45(5.62)                    HAART and after one year completion of HAART, each
CI95% 0.563-0.745, Commercial sex workers -50(6.25%)                   individual of 29 items were pooled and compiled for mean
CI 95% 0.321-0.874, Vendor -55(6.87%) CI 95% 0.44-0.99,                total scores. The mean total score before inception of
Skilled workers -30(3.75%) CI 95% 0.211-0.365, Asst                    HAART for physical domain was 58.10±102.10,
workers- 45(5.62%) CI 95% 0.453-0.869, Salaried class -                Psychological -32.08± 660.03, Social relationship with
42(5.25%), CI 95% 0.486-0.756, Businessmen -76(9.50%)                  others- 18.15±59.32 and Environmental-13.11±98.10. After
0.11-0.201 and Drivers registered for HIV care were more               one year completion of HAART , the impact of effective
and accounted for 315(39.37%) CI 95% 0.453-0.698, the                  counseling , good adherence and clinical parameters had
drivers are the bridge population for HIV transmission.                increased the HRQL level ,the mean score of Physical
 Most of the patients were of low income group ie,                     domain      recorded      was    119.20±30.20,Psychological
563(70.37%) CI 95% 1.24-2.48 and high income group- 89                 83.16±17.62,       Social    relation    65.16±38.12      and
(11.12%) CI 95% 2.48-6.56.                                             Environmental domain 50.02±40.62 (Tab-2). Based on the
                                                                       above facts , present study concluded that, the prevalence
Patients registered for HIV Care belonged to different                 of Psychological factor (Communalities 52.0 and Eigen
religions. Hindus- 655(81.87%) CI 95% 0.112-0.856,                     value is5.46) in HIV-infected population has ranged from 52
Muslims -102(12.75%) CI 95% 0.236-0.78 and Christians-                 – 54 % Younger age, unemployment, lack of health
43(5.375) CI 95% 0.24-0.63,                                            insurance, low CD4+ cell counts, HIV-related symptoms,
                                                                       not having a partner, poor quality of social support, negative
Nuclear families -440(55%) CI 95% 2.36-4.56, Joint                     feelings of blue mood ,lack of family support ,unsatisfied
families- 231(28.87%) CI 95% 1.28-6.36, and staying alone              sexlife,not happy with personal relationships and use of
-129(15.62%) CI 95% 3.86-7.85.                                         recreational      drugs were significant predictors of
                                                                       depression. Patients with HIV infection who are older than
                                                                       35 years are more likely to suffer from depression, anxiety,

confusion, and fatigue. Insomnia, pain, and emotional                         [2] Clayson DJ, Wild DJ, Quarterman P, Duprat-
disturbances correlated well with depression. The impact of                       Lomon I, Kubin M, Coons SJ. A comparative
psychiatric co morbidities, specifically depression, on the                       review of health related quality of life measures for
HRQOL of patients with HIV disease has been well                                  use       in      HIV/AIDS        clinical     trials.
documented. [39], the presence of a major psychiatric                             Pharmacoeconomics. 2006;24:751-65.
disorder (independent of HIV-related disease progression)
was associated with a negative impact on HRQOL                                [3] Fauci AS. The AIDS Epidemic: Considerations for
dimensions of mental health, social functioning, and general                      the 21st Century. N Engl J Med 1999;341:1046-50.
health perceptions but not on physical health, role
functioning, or pain. [41] A larger study showed that patients                [4] Walker N, Grassly NC, Garnett GP, Stanecki KA,
with comorbid mood disorders had significantly worse                              Ghys PD. Estimating the global burden of
functioning and well-being than those without mood                                HIV/AIDS: What do we really know about the HIV
disorders.                                                                        pandemic? Lancet 2004;363:2180-5.

CONCLUSION:                                                                   [5] Beck EJ, Miners AH, Tolley K. The cost of HIV
Quality of life is a multi dimensional concept whose                              treatment  and   care:    A   global   review.
definition and assessment remains controversial. HIV/AIDS                         Pharmacoeconomics 2001;19:13-39.
has a high economic impactonsociety. Overall self-
perception of QOL has been shown to be a useful                               [6] Halloran J. Increasing survival with HIV: Impact on
screening tool for assessing global QOL. QOL relates both                         nursing care. AACN Clin Issues 2006;17:8-17.
to adequacy of the material circumstances and to the
personal feelings about these. As health is generally cited                   [7] Kassutto S, Maghsoudi K, Johnston MN, Robbins
as one of the most important determinants of overall QOL, it                      GK, Burgett NC, Sax PE, et al. Longitudinal
has been suggested that QOL may be uniquely affected by                           analysis of clinical markers following antiretroviral
specific disease processes such as AIDS. There is a lack of                       therapy initiated during acute or early HIV Type I
clarity in defining QOL and concomitant operational                               infection. Clin Infect Dis 2006;42:1024-31.
difficulties in it ,but still there is urgency in evaluating the
QOL in HIV-infected individuals. Future studies should                        [8] Aranda-Naranjo B. Quality of life in HIV-positive
encompass the evaluation of more determinants of QOL in                           patient. J Assoc Nurses AIDS Care 2004;15:20-7.
HIV/AIDS. The constellations of HIV-related symptoms
negatively affect the QOL for people living with HIV                          [9] Hays RD, Cunningham WE, Sherbourne CD,
infection. Effective management of symptoms is important                          Wilson IB, Wu AW, Cleary PD, et al. Health-related
for improving QOL and potentially for maintaining a                               quality of life in patients with human
complicated daily regimen of ART. As HIV disease is                               immunodeficiency virus infection in the United
among the most devastating of illnesses, having multiple                          States: Results from the HIV Cost and Services
and profound effects upon all aspects of life, the evaluation                     Utilization Study. Am J Med 2000;108:714-22.
of QOL is very important. Although research has suggested
relationship among various factors like ,psychosocial ,                       [10] Mannheimer SB, Matts J, Telzak E, Chesney M,
environmental factors, Social relation, stigma discrimination                      Child C, Wu AW, et al. Quality of life in HIV-
and physical health. Much more research is still needed to                         infected individuals receiving antiretroviral therapy
document their potential influence on immune function, as                          is related to adherence. AIDS Care 2005;17:10-22.
well as health status, disease progression, and QOL among
persons with HIV disease. It is also important to underline                   [11] Ruiz Perez I, Rodriguez Baρo J, Lopez Ruz MA,
the role of consultation-liaison psychiatry in the diagnosis                       del Arco Jimenez A, Causse Prados M, Pasquau
and treatment of HIV and AIDS. Stress management                                   Liaρo J, et al. Health-related quality of life of
interventions for HIV-infected persons are a promising                             patients with HIV: Impact of sociodemographic,
approach to facilitate positive adjustment. Additional                             clinical and psychosocial factors. Qual Life Res
research is needed to further evaluate the role of routine                         2005;14:1301-10.
QOL assessment in patients who have HIV/AIDS. The
factorial analysis model is more reliable statistical model                   [12] Swindells S, Mohr J, Justis JC, Berman S, Squier
and it can be made use of, to find out the latent effects of                       C, Wagener MM, et al. Quality of life in patients
QOL domain in HIV infectedpopulation.                                              with human immunodeficiency virus infection:
                                                                                   Impact of social support, coping style and
ACKNOWLEDGEMENT:                                                                   hopelessness. Int J STD AIDS 1999;10:383-91.
The author acknowledges the National AIDS Control
                                                                              [13] Ruiz-Pιrez I, Olry de Labry-Lima A, Lσpez-Ruz MA,
organization New Delhi, Karnataka State AIDS Prevention
society.                                                                           del Arco-Jimιnez A, Rodrνguez-Baρo J, Causse-
                                                                                   Prados M, et al. Clinical status, adherence to
                                                                                   HAART and quality of life in HIV-infected patients
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